Preliminary Long-Term Results of Homeopathic Treatment of ...

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Open Access

OBM Integrative and

Complementary Medicine

Research Article

Preliminary Long-Term Results of Homeopathic Treatment of Atopic Diseases in Adult Patients

Elio Rossi *, Marco Picchi, Marialessandra Panozzo, Linda Nurra

Ambulatorio di omeopatia, Padiglione B, Cittadella della Salute-Ospedale Campo di Marte, 55100

Lucca, Italy; E-Mails: [email protected], [email protected], [email protected],

[email protected]

* Correspondence: Elio Rossi; E-Mail: [email protected]

Academic Editor: Mariella Di Stefano

Special Issue: Experience and activities of the Regional Tuscan Centre for Integrative Medicine

OBM Integrative and Complementary Medicine

2019, volume 4, issue 2

doi:10.21926/obm.icm.1902038

Received: November 01, 2018

Accepted: June 03, 2019

Published: June 20, 2019

Abstract

Background: Since the incidence of allergic diseases and asthma is increasing worldwide,

particularly in Western countries, there is an increasing need to find novel interventions to

treat them. Globally, 300 million people suffer from asthma, 200 to 250 million from food

allergies, 20-25 million from drug allergies, and 400 million from rhinitis.

Aim: To study the effects of homeopathic therapy on adult patients affected by atopic

diseases, who were examined at the Homeopathic Clinic of Lucca (Italy), and monitor the

long-term development of their condition over a period of approximately eight years.

Materials and Methods: An observational longitudinal study was conducted on adult

patients with atopic diseases that were treated at the clinic from 1998 to 2017. In addition, a

long-term study was conducted on a subset of 45/104 adult patients that were examined

from 2006 to 2012, with a follow-up of more than five years. The results were assessed in

relation to the Impact on Daily Living (ORIDL) scale. An evaluation was made during each

patient’s visit, during which the patient described his or her clinical situation, which was

translated into a score by the doctor.

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OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902038

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Results: A total of 563 adult patients were monitored. Of them, 202 (35.9%) patients

suffered from atopic dermatitis (AD), 204 (36.2%) from allergic rhinitis (AR), and 157 (27.9%)

from asthma. Among the treated patients, 69.3% showed a moderate to major improvement

(71.1% in case of asthma as the primary disease, 69.8% in AR, and 67.1% in AD). At re-

examination after 5-12 years, a complete remission of the atopic symptoms was observed in

69.5% of the subjects (100% for AD, 59.2% for AR, and 75% for asthma). Adults with more

than one atopic disease on the first examination were recovered completely in 54.3% of the

cases.

Conclusions: The findings seem to confirm that homeopathic therapy can yield positive

results in adults with atopic diseases.

Keywords

Atopic diseases; adult patients; homeopathic treatment; short- and long-term results

1. Introduction

The term "atopy" was introduced in 1923 by Coca and Cooke and originated from the Greek

word άtopıa, meaning "out of place" [1]. Atopy refers to an inherited tendency to produce IgE in

response to small amounts of common environmental antigens. This term was originally limited

only to asthma and allergic rhinitis (AR), but in 1933, its use was extended to include atopic

dermatitis (AD). More recently, the term “allergic march” was introduced to refer to the natural

progression of atopic disorders. This begins with dermatitis and the concomitant sensitization to

food and aeroallergens in early childhood, and then progresses to asthma and AR in later

childhood or adulthood [2].

The prevalence of allergic diseases and asthma is increasing worldwide, particularly in Western

countries. Globally, about 200 to 250 million people suffer from food allergies. According to the

World Health Organization, 300 million people have asthma and based on the rising trends, this

figure is expected to increase to 400 million by 2025 [3]. Over 500 million people are affected by

AR [4], with widely varying country-wise figures (5-40%). It generally develops during late

childhood but is most common in adults between 20 and 40 years of age, after which the

incidence gradually diminishes. In several subjects with hay fever, symptoms decline in mid- and

late adulthood. These symptoms appear in response to grass and tree pollen, indoor allergens

including furry pets, and household dust mites [5]. Most individuals present seasonal symptoms

but around 25% experience perennial symptoms.

Recently, the use of complementary and alternative medicine (CAM) in the treatment of

immunological and allergic conditions has increased. According to the National Center for

Complementary and Integrative Health (NCCIH), the term "complementary and alternative

medicine" refers to medicinal products and practices that are not part of standard medical care. If

a non-mainstream practice is used in combination with conventional medicine, it is termed

as “complementary”. If it is used instead of conventional medicine, it is called “alternative” *6+.

Worldwide, over 200 million people use homeopathic treatment on a regular basis and 29% of

the EU’s population use homeopathic medicine for routine healthcare *7+. In Italy, 21.2% of the


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population (+ 6.7% compared to 2012) relies on complementary medicines, of which homeopathy

is the most preferred (76.1%) [8].

A recent survey on the use and adverse effects of CAM was carried out by members of the

American Academy of Allergy, Asthma, & Immunology (AAAAI), who examined patterns of usage

of CAM and reported that 81% of the practitioners that responded to the survey had patients

using CAM treatment instead of conventional therapies [9]. More than 20% of the population of

the United States suffers from atopic disorders such as asthma, AR, and AD, of which over 42%

(both adults and children) have used CAM for treatment of their atopic disorders [10]. The

prevalence of CAM for the treatment of allergic diseases is even higher in certain European

countries [11]. Several different studies in the literature have demonstrated the effectiveness of

homeopathy in AR [12-15], asthma [16-20], and AD [21-27].

1.1 The Homeopathic Clinic, Lucca

The Homeopathic Clinic at Lucca (Italy) was established as a pilot project in 1998 with funding

from the Region of Tuscany. The aim of this project was to investigate whether complementary

medicine (CM) could be included in the public healthcare system [28]. In 2002, a Regional

Reference Centre for homeopathy was established at Lucca [29], and since 2017, the Homeopathic

Clinic of Lucca has acted as the CM Coordination Center for the Local Health Authority Tuscany

North-West [30].

In 2012, we published a study on the long-term progression of atopic diseases in children that

were treated with homeopathy at the Homeopathic Clinic of Lucca and followed up after

approximately eight years (range 5-10 years) [31]. In 2016, we extended the scope of our research

to AR and asthma as well [32]. We treated several patients with atopic diseases in whom the onset

of the disease occurred in adulthood. In early adulthood and middle age, respiratory and skin

manifestations are typically related to occupational exposures, lifestyle, and habits such as

tobacco smoking. Although allergic symptoms tend to decrease and disappear during late

adulthood, some patients develop new-onset allergy or asthma in old age [33]. There is a lack of

information regarding the prevalence and prognosis of atopic diseases in adults.

This study aims to fill that gap by analyzing the short- and long-term outcomes of homeopathic

treatment of atopic diseases in adult patients.

2. Aim of the Study

Our aim was to study the effects of homeopathic therapy on adult patients that were affected

by atopic diseases and examined at the Homeopathic Clinic of Lucca between 1998 and 2017, and

to assess the long-term development of atopic symptoms in subjects with a follow-up after at

least five years from the first homeopathic consultation.

3. Materials and Methods

3.1 Design

This retrospective observational cohort study involved two groups: 1) all the adult patients that

were suffering from atopic diseases and were examined at the Homeopathic Clinic of the Campo


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di Marte Hospital of Lucca between 1998 and 2017, and 2) a subset of group 1 having a long-term

follow up.

Inclusion criteria for the first group were adulthood, ongoing atopic diseases, and examination

at the Homeopathic Clinic of Lucca. Inclusion criteria for the second group included a long-term

follow up after ≥ five years from the first homeopathic visit.

The personal and clinical data used for this research were stored and processed electronically

in a database.

3.2 Setting

The homeopathic physicians of the clinic were medical practitioners that had attended a

homeopathy school for at least three years and had over 25 years of experience in homeopathy.

They were registered as experts of homeopathy with the Provincial Medical Council according to

the Tuscan law no. 9/2007 [34] and the related Agreement Protocol of 2015 [35]. The average

waiting time for appointments at the clinic was 1-2 months. A homeopathic examination lasted for

about 30 min and consisted of a detailed interview with the patient, a physical examination, and

the analysis of biological and radiological tests.

3.3 Patients

The patients that were examined at the Homeopathic Clinic from 1998 to 2017 were either

referred by their general practitioner or were self-referred. There were no specific criteria for

admission, and anyone who wished to be treated by homeopathy could request an appointment

(Figure 1).

Figure 1 Recruitment, follow-up, and long-term follow-up analysis of adult patients

with atopic diseases in homeopathic treatment.


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The major respiratory allergens affecting the patients included members of the family

Gramineae, dust mites, and certain trees (birch, poplar, and olive). Although subjects with

dermatitis did not usually report food allergies, they did show evidence of food intolerance, mainly

to milk and its derivatives, nightshades (tomatoes), and eggs.

3.4 Diagnosis

The diagnosis of AD was made using the criteria proposed by Williams and colleagues in 1994

[20]. A diagnosis of AD can be made if a patient has presented with itchy skin or the parents report

having observed scratching or rubbing their child during the past twelve months.

Additional indicators for the diagnosis are the presence of three or more of the following

criteria:

1. History of dermal involvement (bends of arms, wrists, knees, and ankles; creases around

the neck, and eyes (and also the cheeks of children <10 years of age)

2. History of asthma or hay fever (or history of atopic disease in a first-degree relative if

the child is <4 years of age)

3. History of dry skin over the past year

4. The onset of signs and symptoms in children <2 years of age (not valid for children <4

years)

5. Clear flexural dermatitis (or dermatitis involving the forehead, cheeks, or the outer

aspect of limbs in children <4 years).

In addition, the diagnosis of AD depends on the exclusion of other conditions, such as allergic

contact dermatitis, cutaneous lymphoma, seborrheic dermatitis, psoriasis, scabies, ichthyosis, and

features of other primary diseases.

AR and asthma are traditionally subdivided into "persistent" and "intermittent". On the basis of

the ARIA guidelines, the patients that showed allergic symptoms for less than four days per week

or four weeks per year were classified in the intermittent group, while the rest were classified in

the persistent group. Based on the severity of disease, the patients were classified into mild and

moderate-severe groups [36].

3.5 Informed Consent

All the patients involved in this study had to sign a privacy disclaimer and informed consent

form for treatment and use of their data for future analysis. All the patients were assigned an

individual identification number to anonymize, collect, and store the data in a database.

3.6 Therapy

The therapeutic approach consisted of a medical visit in which the patient was examined from

physical and mental perspectives in relation to existing conditions as well as clinical history. The

goal was to identify a "constitutional" remedy (simillimum)–a remedy shown to produce

symptoms (including general, particular, intellectual, and emotional symptoms) with the highest

similarity to those of the patient, in a healthy individual (prover). The similarity could be at the

"whole person" level, which takes into account the symptoms and signs of the disease, the

patient’s physical symptoms, as well as the personality, temperament, and genetic predispositions.


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In acute conditions, this high level of individualization is not always required because ‘similarity’

must be found at a more specific local level. The consideration of the new or most recent

symptoms for the selection of the remedy helped in matching the remedy to the current acute

picture.

Homeopathic therapy generally consisted of the prescription of a single remedy in

Quinquaginta Millesimal (Q or LM) potencies, starting with Q6 and continuing on a progressive

scale of potencies, from Q6 to Q9, Q12, Q18, Q24, Q30, and sometimes Q60, generally for at least

60 days for each potency [37]. The remedies in centesimal and low potencies (6 to 30 CH) were

used in acute cases. In addition, single doses of high centesimal potencies (200, M, or XM) were

also prescribed after treatment with Q potencies.

During the first examination, patients who were suffering from chronic or recurrent diseases

and were previously treated with conventional drugs were advised to slowly reduce and

eventually discontinue them, following gradual improvement by homeopathic therapy. The

patients with acute illnesses were advised on which homeopathic remedies should be taken, or

were directed to conventional treatment in case of failure of the homeopathic remedies.

We generally used individualized homeopathic treatment, which was managed differently in

acute versus chronic situations. In the case of AD, the topical use of basic moisturizing cream and

Calendula cream was recommended.

3.7 Outcome Parameters

In order to understand the response to homeopathic treatment, we considered adult patients

with at least one follow-up visit. Follow-up examinations were carried out after a minimum of two

months and after 6, 12, and 18 months, and possibly during the 2nd, 3rd, 4th, 5th year, and so on.

Information such as demographic data of the patients; clinical diagnoses according to ICD 10

coding; type, potency, and dosage of the prescribed remedy; prescription strategy; and the

classification of the case as acute, chronic, or recurrent was recorded on paper and included in a

database via the computerized clinical record ‘Win-Computerized Homeopathic Investigation

Program’ (C.H.I.P.) *38+.

The results were assessed in relation to the Impact on Daily Living (ORIDL) scale [39], formerly

called the Glasgow Homeopathic Hospital Outcomes Scale or GHHOS [40]. The ORIDL reference

values defined different degrees of improvement: 0 = no change/unsure; +1 = slight improvement,

no effect on daily living; +2 = moderate improvement, affecting daily living; +3 = major

improvement; +4 = cured/back to normal; -1 = slight deterioration, no effect on daily living; -2 =

moderate deterioration, affecting daily living; -3 = major deterioration; -4 = disastrous

deterioration. Our tables did not include the values of -2, -3, and -4 as no patient response

achieved a score of lower than -1. The scores were assigned during the visit of each patient, during

which the patient described his or her clinical situation, which was translated into a score by the

doctor.

We utilized the following criteria to define the physical seriousness of atopic eczema: (1) Clear:

Normal skin with no signs of active atopic eczema; (2) Mild: Patches of dry skin and sporadic

itching (with presence or absence of small red areas); (3) Moderate: Dry skin areas with recurrent

itching and redness (presence or absence of excoriation, localized thickening, and tightness of the


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skin); and (4) Severe: Large areas of dry skin, constant itching, redness (with or without excoriation,

widespread skin thickening, bleeding, oozing, cracking, and pigment alteration) [41].

The condition of patients having asthma and AR was classified as follows: (1) mild intermittent

(episodic), (2) mild persistent, (3) moderate persistent, and (4) severe persistent, wherein the term

‘intermittent’ describes symptoms occurring for <4 days/week for <4 consecutive weeks a year,

while ‘persistent’ describes symptoms occurring for >4 days/week for >4 consecutive weeks a year

[42].

3.8 Long-Term Evaluation

Of the 104 adult patients that were re-evaluated between 2006 and 2012, only 53 patients

(50.9%) could be contacted, although only 46 (44.2%) provided useful information. Forty-six

patients (44.2%) were unreachable because of relocation and/or telephone number change and

12 (11.5%) have not yet been found. Of the 46 patients that responded, 19 (41.3%) were male and

27 (58.7%) were female. The mean age was 37.63 ±16.7, with 23 (50%) aged between 15 and 34

years, 19 (41.3%) between 35 and 64 years, and 4 (8.7%) over 64-years-old.

The patients were asked to return to the clinic for a follow-up evaluation. We gathered the data

through a questionnaire survey conducted during the visit or telephonically and evaluated the

principal atopic disease and the overall pattern of symptoms.

The aim of our questionnaire was to evaluate the development of the principal symptoms, the

overall pattern at re-evaluation, and the development of any diseases that was absent during the

first visit. It should be noted that some patients continued homeopathic treatment in private

clinics in the interim period.

The average long-term follow-up (≥ five years) was 8.2 years (8.1 years for allergic dermatitis,

8.2 years for AR, and 8.2 years for asthma).

3.9 Statistical Analysis

Well-trained personnel at the Homeopathic Clinic performed the entry, screening, encoding,

and analysis of the data. The results were analyzed statistically using the Wilcoxon’s test applied to

matched-pair samples associated with a two-tailed significance test, using the statistical software

package PASW (release 18.1 of SPSS, Statistical Package for Social Sciences).

4. Results

A total of 4,152 patients were consecutively examined at the Homeopathic Clinic of Campo di

Marte Hospital in Lucca from September 1998 to December 2017. Of these, 916 (22.1%) were

patients with atopic diseases, of which 353 (38.5%) were pediatric patients (≤ 14 years) and 563

(61.5%) were adults (≥ 15 years).

Table 1 shows the characteristics of the patients with the atopic disease, as well as the two

subgroups of children and adults. Among these patients, 295 (32.2%) suffered from asthma, 281

(30.7%) from AR, and 340 (37.1%) from AD. The adult subgroup of 563 patients (mean age 38.64

years) represented 61.5% of the atopic patients (compared to 353 or 38.5% children). In the adult

subgroup, we observed asthma in 157 (27.9%) patients, AR in 204 (36.2%) patients, and AD in 202

(35.9%) patients.


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Unlike the pediatric subgroup that consisted of 60.6% males, the adult subgroup was largely

represented by females (63.9%). In addition, 84.5% of the adult patients had already used

conventional treatment for the existing disease at the time of the first visit, and only 22.7% were

previously treated with homeopathic remedies.

In adults, no significant correlation was observed between the age and the variables indicated

in Table 1, except for patients with AR who were more numerous in the age group of 15-40 years

(42.4%) than in the ≥ 41-year group (28.3%).

Each patient was examined 1 to 5 times and a total of 261 (46.4%) adult patients underwent at

least one follow-up visit. There were no significant differences between patients with and without

follow-up, in terms of demographic and clinical features.

Table 1 Age-wise characteristics of all atopic patients (sex, previous use of

conventional treatment, previous use of homeopathic treatment, atopic diseases, and

follow up).

0-14 years >15 years Total Follow-up

Number of patients n. (%) n. (%) n. (%) n. (%)

353 38.5 563 61.5 916 100 442 48.3

Sex

Male 214 60.6 203 36.1 417 45.5 205 46.4

Female 139 39.4 360 63.9 499 54.5 237 53.6

Patients who had already used conventional treatment for the existing disease at the time of

the first visit

Yes 282 79.9 476 84.5 758 82.8 371 83.9

Patients who had already used homeopathic treatment for the existing disease at the time of

the first visit

Yes 72 20.1 136 24.2 208 22.7 107 24.2

Atopic diseases

Atopic dermatitis 138 39.1 202 35.9 340 37.1 143 32.4

Allergic rhinitis 77 21.8 204 36.2 281 30.7 145 32.8

Asthma 138 39.1 157 27.9 295 32.2 154 34.8

Table 2 shows the number and percentage of all adult patients with atopic diseases with follow-

up, grouped by diseases and ORIDL score for severity of symptoms.

There were 261 (46.4%) adult patients with follow-up, of which 106 (40.6%) had AR, 79 (30.3%)

had AD, and 76 (29.1%) had asthma. Fifty-four adult patients with asthma (71.1%), 74 with AR

(69.8%), and 53 with AD (67.1%) showed a major improvement (ORIDL = +2 +3) or resolution

(ORIDL = 4) of the disease. A total number of 181 patients (69.3%) showed major improvement or

resolution.


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Table 2 Results of homeopathic treatment in 261 adult patients with atopic disorders

at follow-up (1998–2017), as evaluated using ORIDL.

Adult atopic

patients with

follow-up

n. 261/563

(46.4%)

ORIDL 0/-1

No changes

or slight

worsening

(%)

ORIDL +1

Slight

improvement

(%)

ORIDL +2

Moderate

improvement

(%)

ORIDL +3

Major

improvement

(%)

ORIDL +4

Resolution

(%)

ORIDL

+2+3+4

(%)

Asthma

(n. 76)

8 14 16 25 13 54

(10.5) (18.4) (21.1) (32.9) (17.1) (71.1)

Allergic rhinitis

(n. 106)

8 24 25 30 19 74

(7.5) (22.6) (23.6) (28.3) (17.9) (69.8)

Atopic dermatitis

(n. 79)

11 15 13 25 15 53

(13.9) (19) (16.5) (31.6) (19) (67.1)

Total

(n. 261)

27 53 54 80 47 181

(10.4) (20.3) (20.7) (30.7) (18) (69.3)

Table 3 summarizes the long-term development of symptoms in 46 followed-up adult patients

with AD, AR, and asthma. In cases where AD was the main disease, 7/7 (100%) patients showed

complete remission. Out of 27 patients with AR as the main disease, 16 (59.2%) presented

complete remission of symptoms, while seven (25%) exhibited mild/intermittent (episodic)

symptoms, three showed moderate/persistent symptoms, and only one (3.7%) continued to show

severe symptoms. Out of 12 patients with asthma, nine (75%) exhibited complete remission of

symptoms, two (16.7%) presented mild/intermittent (episodic) symptoms, and only one (8.3%)

maintained moderate/persistent symptoms.

Of the 46 patients, 35 (76.1%) had exclusively used homeopathy to treat their atopic symptoms

over time, whereas 11 (23.9%) had used and continued to use conventional treatment when

needed, for example, antihistamines during acute seasonal rhinitis. Out of the 35 patients that

exclusively used homeopathy, 27 (77.1%) believed they had completely resolved the atopic

condition, compared to only five of the 11 (45.5%) that used conventional treatment.

Table 4 presents the patients with different atopic diseases and their progression at long-term

follow-up. Out of 46 patients, 24 (53.3%) had other atopic conditions apart from their primary

complaint: 37% had both asthma and AR, 2.2% had asthma and AD, 10.9% had AR and AD, and 2.2%

had asthma, AR, and AD. Twenty-five out of the 46 patients (54.3%) exhibited complete remission

of all associated diseases.

The most frequently and efficaciously prescribed remedies were Sulfur and Silicea for AD,

Pulsatilla pratensis and Arsenicum iodatum for AR, and Natrum sulfuricum and Arsenicum album

for asthma.


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Table 3 Distribution of adult atopic patients by level of severity at first visit and at long-term follow-up (n. 46).

Severity of main symptom (first visit)

Severity of main symptom (at the long-term follow-up visit) Mild intermittent/ sporadic

Mild persistent

Moderate persistent

Severe persistent

Absence/remission

Under homeo treatment

No more treatment

Asthma (n. 12) 2 (16.7%) 0 1 (8.3%) 0 0 9 (75%)

9 (75%) Mild intermittent (episodic)/ sporadic (n. 0)

0 0 0 0 0 0

Mild persistent (n. 2) 0 0 0 0 0 2

Moderate persistent (n. 6) 1 0 1 0 0 4

Severe persistent (n. 4) 1 0 0 0 0 3

Allergic rhinitis (n. 27) 7 (25%) 0 3 (11.1%) 1 (3.7%) 9 (33.3%) 7 (25.9%)

16 (59.2%) Mild intermittent (episodic)/ sporadic (n. 0)

0 0 0 0 0 0

Mild persistent (n. 6) 3 0 0 0 2 1 Moderate persistent (n. 10) 3 0 3 0 1 3 Severe persistent (n. 11) 1 0 0 1 6 3 Dermatitis (n. 7) 0 0 0 0 2 (28.6%) 5 (71.4%)

7 (100%)

Mild intermittent (episodic)/ sporadic (n. 0)

0 0 0 0 0 0

Mild persistent (n. 3) 0 0 0 0 0 3 Moderate persistent (n. 2) 0 0 0 0 1 1 Severe persistent (n. 2) 0 0 0 0 1 1 Total (n. 46) 9 (19.6%) 0 4 (8.7%) 1 (2.2%) 11 (23.9%) 21 (45.6%)

33 (69.5%)


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Table 4 Distribution and progression of atopic diseases in adult patients at first visit

and at long-term follow-up (n = 46).

Overall

symptoms

(ante)

n. pts

Overall symptoms (long-term)

Asthma Rhinitis Dermatitis Asthma

and

rhinitis

Asthma

and

dermatitis

Rhinitisand

dermatitis

Asthma,

rhinitis,

and

dermatitis

Remission

n. pts n. pts n. pts n. pts n. pts n. pts n. pts n. pts %

Asthma (n. 7) 2 0 0 0 0 0 0 5 71.4

Rhinitis (n. 10) 0 4 0 0 0 0 0 6 60.0

Dermatitis

(n. 5)

0 1 0 0 0 0 0 4 80.0

Asthma and

rhinitis (n. 17)

0 3 1 2 0 2 0 9 52.9

Asthma and

dermatitis (n. 1)

0 0 1 0 0 0 0 0 0.0

Rhinitis and

dermatitis (n. 5)

0 4 0 0 0 0 0 1 20.0

Asthma,

rhinitis, and

dermatitis (n. 1)

0 1 0 0 0 0 0 0 0.0

Total (n. 46) 2 13 2 2 0 2 0 25 54.3

5. Discussion

As this was a retrospective study reporting only clinical activity, we could not compare the

results with a control group. Thus, it was possible that the results were influenced by the natural

course of atopic disease, although it should be noted that adults do not commonly show

spontaneous cure, and 84.5% of our patients (see Table 1) underwent a lengthy period of

conventional treatment without any success.

In a 2006 study on 79 adults (mean age 57 years) that received only conventional treatment, 68%

reported an ongoing incidence of AD, 53% reported eczema, and 12% complained of severe AD

during the follow up after three years [43]. These results suggest that when atopic diseases persist

during adulthood, it will usually continue for many years. Although complete remission is possible

in adult asthma, remission rates are low and limited to milder cases. Longitudinal studies have

indicated that severe asthma has a poorer prognosis and is associated with an increased likelihood

of permanent lung function impairment, hospitalization, and mortality [44].

In a study performed at 35 Italian healthcare centers, only 304 patients out of 2,760 (12.2%)

with allergic rhinitis that had responded to questionnaires said that the response to conventional

treatment was excellent, while 1027 responded ‘good’ (41.3%), 775 ‘fair’ (31.2%), 359 ‘poor’

(14.5%), and 19 said ‘very bad’ (0.8%). In this study, 340 (13.7%) patients were highly satisfied with

the treatment, 1425 were satisfied (57.3%), 703 were not satisfied (28.3%), and 18 were


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extremely dissatisfied (0.7%). The extent of dissatisfaction was significantly higher in patients with

moderate-to-severe AR, compared to patients with mild AR (p<0.0001) [45].

The efficacy of homeopathy needs to be demonstrated with randomized controlled trials to

confirm the results observed in this study.

Social changes over the past few years have made it more difficult to locate patients for long-

term follow up after some time. The exclusive use of mobile phones in several families and the

lack of mobile phone directories in Italy made it difficult to reach some patients.

The present study evaluated patients via a face-to-face or telephonic follow-up after

approximately 7–8 years from the start of homeopathic treatment, in order to understand

whether any improvements from homeopathic treatment were sustainable in the long term.

In previous studies [31 3̧2] we analyzed the outcomes of pediatric patients with AD, who were

treated at the same clinic. The first study focused exclusively on AD and was followed by another

study on all the atopic diseases: AD, AR, and asthma. The second study revealed that 75.8% of the

examined children (67.1% with asthma as the primary disease, 84.2% with rhinitis, and 84.2% with

dermatitis) presented moderate to major improvement. At re-evaluation after 5–10 years,

complete remission of the atopic symptoms was observed in 70.1% of the children: 84.2% with AD,

48.1% with AR, and 71.4% with asthma. Forty percent of the children with two or three

concomitant atopic diseases at first examination had completely recovered.

Based on these positive outcomes, we investigated whether similar results could also be

obtained in adults with atopic diseases, or whether the positive response of pediatric patients was

due to factors such as young age and possibly a healthier diet or reduced pharmacological

intoxication.

The findings of this study confirm that the homeopathic treatment of atopic diseases is

effective in adult patients as well. The rates of success are similar, although slightly lower than

those observed in pediatric patients. In short-term evaluation, major improvement or resolution

was obtained in 69.3% of the adults compared to 75.8% of the children.

More specifically, we observed that the results of all atopic diseases are not the same in adults

and children. Major improvement (ORIDL+2+3+4) was observed in 71.1% of the adults vs. 67.1% of

children with asthma; 69.8% of the adults vs. 84.2% of children with AR; and 67.1% of the adults

vs. 84.2% of children with AD. Therefore, homeopathic treatment of asthma seems to be more

effective in adults than in children, while children with AR and AD seem to respond better to

homeopathic treatment.

In addition, among patients with long-term follow up, those who chose exclusive homeopathic

treatment appeared to show better results, with the resolution of atopic symptoms in 77.1% of

the cases (versus 45.5% in patients that chose conventional treatment). This can be explained by

the fact that patients that obtain good results from homeopathic treatment tend to exclusively

utilize homeopathy, whereas patients that obtain inferior results with homeopathy tend to also

use conventional treatment.

In the long-term assessment of patients that were affected by concomitant atopic diseases, 40%

of the pediatric patients (30 cases) showed complete remission of all associated diseases,

compared to 54.3% of the adult patients (46 cases).

Long-term follow up in adults demonstrated that homeopathic treatment reduced the severity

of symptoms even when AD, AR, and asthma persisted over time, which is in contrast to what

generally occurs with conventional treatment.


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These results, if confirmed with randomized controlled trials in a larger sample of patients both

in the acute phase (for example in the case of seasonal pollen allergies) and in the chronic state,

could yield important practical consequences. An integrated treatment model for atopic diseases

could be developed with the systematic use of homeopathic treatment preceding conventional

medicines (antihistamines, cortisones, etc.), limiting their use to only the more severe and acute

cases. Furthermore, homeopathic treatment may also be paired with conventional desensitization

therapy.

6. Conclusions

The results of our study demonstrate that homeopathy has positive therapeutic effects not

only in children suffering from atopic diseases, as shown in previous studies but also in adults.

According to these preliminary data, adult patients treated with homeopathy appeared to

show a more significant reduction in the severity of atopic diseases and even a complete remission

at long-term follow-up, compared to results of conventional treatment that are reported in the

literature.

Acknowledgments

We thank Dr. Laura Cignoni for her English translation and Dr. Mariella Di Stefano for

contributing to the bibliographic research and the revision of the text.

Author Contributions

Research conducted by the authors. Elio Rossi carried out the clinical activities and conceived,

designed, and participated in the research and wrote the article. Marco Picchi participated in the

data analysis, the statistical analysis, and writing the article. Marialessandra Panozzo participated

in the writing and discussion of the article. Linda Nurra took part in the data analysis and writing of

the article.

Competing Interests

There are no conflicts of interest.

Funding

This study was supported by the public health system of the Region of Tuscany (Italy).

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